Healthcare Provider Details

I. General information

NPI: 1730423005
Provider Name (Legal Business Name): KAREN S STARK MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2012
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10117 N 92ND ST SUITE 103
SCOTTSDALE AZ
85258-4555
US

IV. Provider business mailing address

PO BOX 20610
MESA AZ
85277-0610
US

V. Phone/Fax

Practice location:
  • Phone: 480-747-6532
  • Fax: 480-899-6865
Mailing address:
  • Phone: 480-985-1093
  • Fax: 480-296-7643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25769
License Number StateAZ

VIII. Authorized Official

Name: KAREN S STARK
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 602-402-0478